Department of Justice Activities Under the

Civil Rights of Institutionalized Persons Act Fiscal Year 2013

Table of Contents

I. Introduction and Overview 2

II. Filing of CRIPA Complaints/Resolution of Investigations and Lawsuits

A. Resolution of Investigations 3

III. Prison Litigation Reform Act 6

IV. Compliance Evaluations 6

V. Termination of CRIPA Cases 10

VI. New CRIPA Investigations 10

VII. Findings Letters 10

VIII. Investigation Closures 12

IX. Technical Assistance 13

X. Responsiveness to Allegations of Illegal Conditions 13

XI. Conclusion 15

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I. Introduction and Overview

Individuals confined in institutions are often among the most vulnerable in our society.

Recognizing the need to protect the rights of those residing in public institutions, Congress in

1980 passed the Civil Rights of Institutionalized Persons Act (CRIPA). CRIPA gives the

Attorney General the authority to investigate conditions at certain residential institutions

operated by or on behalf of state and local governments—including facilities for individuals with

psychiatric or developmental disabilities, nursing homes, juvenile justice facilities, and adult jails

and prisons—to determine whether there are violations of the Constitution or federal law.

CRIPA enforcement has been delegated to the Department of Justice’s Civil Rights Division

(“the Division”). CRIPA is enforced by the Division’s Special Litigation Section (“the

Section”).

If a pattern or practice of unlawful conditions deprives individuals confined in the

facilities of their constitutional or federal statutory rights, the Division can take action. As

required by the statute, the Division engages in negotiation and conciliation efforts and provides

technical assistance to help jurisdictions correct deficient conditions. If these efforts fail, the

Division may file a lawsuit to correct the violations of rights.

The Division takes very seriously its responsibility to protect the rights of individuals

residing in institutions. Over the last year, the Division has achieved important successes

throughout all areas of its CRIPA authority. For instance, the Division opened a new

investigation targeted to maximize impact on the issue of sexual abuse of female prisoners. The

Division issued letters describing the findings of investigations that broke new ground on

cutting-edge issues in its civil rights enforcement. The Division has vigorously enforced

settlements to ensure that the rights of the individuals protected by those decrees are vindicated.

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The Division has engaged in extensive outreach to stakeholders and the community to ensure

that their concerns are reflected in its enforcement efforts. Finally, the Division has been

involved in policy initiatives that implicate the work of the Section and advance the civil rights

of those protected by CRIPA.

In Fiscal Year 2013, the Division filed four complaints and entered into five settlement

agreements. The Division also initiated a CRIPA investigation of a prison and issued two

findings letters outlining findings of significant constitutional and federal statutory violations at

two facilities.1 At the end of Fiscal Year 2013, the Division had active CRIPA matters and cases

involving 93 facilities in 25 states, the District of Columbia, the Commonwealths of Puerto Rico

and the Northern Mariana Islands, and the Territories of Guam and the Virgin Islands.

As envisioned by Congress, enforcement of CRIPA continues to identify egregious and

flagrant conditions that subject residents of publicly operated institutions to grievous harm.

42 U.S.C. § 1997a (a). In addition to its enforcement efforts at state and local facilities, pursuant

to Section f(5) of CRIPA, the Division provides information regarding the progress made in each

federal institution (specifically from the Bureau of Prisons and the Department of Veterans

Affairs) toward meeting existing promulgated standards or constitutionally guaranteed

minimums for such institutions. See attached statements.

II. Filing of CRIPA Complaints/Resolution of Investigations and Lawsuits

A. Resolution of Investigations

1. Maple Lawn Nursing Home, Missouri

In March 2013, the Division and Marion County, Missouri, reached a settlement

agreement to correct unlawful conditions at the Maple Lawn Nursing Home and to assist

1 The full text of these findings letters can be found at the Division’s website at http://www.usdoj.gov/crt/split/index.html.

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residents of this facility in moving to integrated settings with appropriate supports, when they

were able and willing to do so. In January 2011, the Division had issued findings that the Maple

Lawn Nursing Home failed to provide services to individuals in the most integrated setting

appropriate to their needs and to prevent unconstitutional harms or minimize risk of harms. The

settlement agreement will require the jurisdiction to implement preadmission diversion practices,

discharge and transition planning, adequate and appropriate medical care, and procedures to

protect residents from harm. The agreement is monitored by a court monitor who issues

compliance reports.

2. Robertson County Detention Facility, Tennessee

In April 2013, the Division reached a settlement agreement with Robertson County,

Tennessee, to transform care for prisoners suffering from mental illness at the Robertson County

Detention Center. In August 2011, the Division had issued findings that the Detention Center

failed to provide mental health care to prisoners, placing prisoners at a substantial and

unreasonable risk of serious harm. The settlement agreement will require the County to provide

proper treatment to prisoners who have mental illness or are at risk of suicide, including

treatment necessary to successfully reenter the community. An independent consultant will

monitor compliance with the agreement and issue public compliance reports.

3. Miami-Dade County Jail, Florida

In May 2013, the Division and Miami-Dade County, Florida, reached a settlement

agreement to remedy unconstitutional conditions for prisoners at the Miami-Dade County Jail. In

August 2011, the Division had issued findings that Miami-Dade County Jail failed to provide

prisoners with adequate mental health care and suicide prevention, protection from physical

harm, and sanitary and safe conditions. The settlement agreement requires the Jail to implement

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practices to protect prisoners from unnecessary or excessive force by staff and other inmates.

The agreement also requires the Jail to provide prisoners with a process to express grievances

and a safe environment. The Jail must implement self auditing measures to address prisoners’

constitutional rights and develop and implement policies and procedures to ensure compliance

with the agreement. A monitor will evaluate compliance with the agreement and provide

technical assistance to the County as requested.

4. Piedmont Regional Jail Authority, Virginia

In September 2013, the Division and the Piedmont Regional Jail Authority reached a

settlement agreement to remedy unconstitutional conditions at the Jail. In September 2012, the

Division had issued findings that the Piedmont Regional Jail Authority violated the constitutional

rights of prisoners. The settlement agreement requires the Jail to provide prisoners with adequate

medical and mental health care, including chronic care. The agreement also requires the Jail to

implement a reporting system to identify deficiencies in care in a timely manner and implement

other measures to facilitate prisoners’ access to adequate health care. The agreement is

evaluated by a monitor, who issues public compliance reports and provides technical assistance

to the Jail.

5. St. Tammany Parish Jail, Louisiana

In August 2013, the Division and St. Tammany Parish, Louisiana, signed a Memorandum

of Agreement to remedy unconstitutional conditions at the Jail. In July 2012, the Division found

that the Jail failed to provide prisoners with adequate mental health care and suicide prevention.

The agreement requires improved screening and assessment, adequate and timely mental health

treatment, enhanced staff training, and data collection. The agreement also builds upon

improvements made by the Parish during the Division’s investigation--most notably the removal

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of small booking cages that were used for the confinement of suicidal prisoners, and the

construction of a specialized housing unit to manage and monitor prisoners suffering from

mental health crises. Compliance with the agreement will be assessed by an independent auditor,

who will periodically inspect the Jail, issue written reports of compliance, and provide technical

assistance as needed.

III. Prison Litigation Reform Act

The Prison Litigation Reform Act (PLRA), 18 U.S.C. ' 3626, enacted on April 26, 1996,

covers prospective relief in prisons, jails, and juvenile justice facilities. The Division has

defended the constitutionality of the PLRA and has incorporated the PLRA’s requirements in the

remedies it seeks regarding improvements in correctional and juvenile justice facilities.

IV. Compliance Evaluations

During Fiscal Year 2013, the Division monitored compliance with CRIPA consent

decrees, settlement agreements, and court orders designed to remedy unlawful conditions in

numerous facilities throughout the United States. These facilities are:

A. Facilities for persons with developmental disabilities:

Facility or Facilities Case or Agreement Court/Date

Arlington Developmental Center United States v. Tennessee, 92-2026HA W.D. Tenn. 1992

Clover Bottom Developmental Center and Harold Jordan Center

United States v. Tennessee, 3:96-1056 M.D. Tenn. 1996

Centro de Servicios Multiples Rosario Bellber

United States v. Commonwealth of Puerto Rico, 99-1435 D. P.R. 1999

Woodbridge Developmental Center United States v. New Jersey, 3:05-CV-05420(GEB) D. N.J. 2005

Beatrice State Developmental Center United States v. Nebraska, 08-08CV271-RGK-DL D. Neb. 2008

Abilene State Supported Living Center; Austin State Supported Living Center; Brenham State Supported Living Center; Corpus Christi State Supported Living Center; Denton State

United States v. Texas, A-09-CA-490 E.D. Tex. 2009

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Supported Living Center; El Paso State Supported Living Center; Lubbock State Supported Living Center; Lufkin State Supported Living Center; Mexia State Supported Living Center; Richmond State Supported Living Center; Rio Grande State Supported Living Center; San Angelo State Supported Living Center; and San Antonio State Supported Living Center Georgia Regional Hospital in Atlanta, Georgia Regional Hospital in Savannah, Central State Hospital, Southwest State Hospital, West Central Georgia Regional Hospital and East

United States v. Georgia, 1-09-CV-0119

N.D. Ga. 2009

Central Georgia Regional Hospital. (These facilities also serve people with mental illness.)

United States v. Georgia 01-10-CV-0249

N.D. Ga. 2010

B. Facilities for persons with mental illness:

Facility or Facilities Case or Agreement Court/Date Metropolitan State Hospital; Napa State Hospital; Atascadero State Hospital; and Patton State Hospital

United States v. California, 06-2667 GPS M.D. Cal. 2006

St. Elizabeth’s Hospital United States v. District of Columbia, 1:07-CV-0089 D. D.C. 2007

Georgia Regional Hospital in Atlanta, Georgia; Regional Hospital in Savannah; Central State Hospital; Southwest State Hospital; West Central Georgia Regional Hospital; and East Central Georgia Regional Hospital. (These facilities also serve people with developmental disabilities.)

United States v. Georgia, 1-09-CV-0119 United States v. Georgia 01-10-CV-0249

N.D. Ga. 2009

N.D. Ga. 2010

Connecticut Valley Hospital United States v. Connecticut, 3:09-CV-00085 D. Conn. 2009

Kings County Hospital Center United States v. Kings County, New York, CV-10-0060 E.D.N.Y. 2010

Delaware Psychiatric Center United States v. Delaware, 1-11-CV-00591 D. Del. 2011

C. Nursing Homes:

Facility or Facilities Case or Agreement Court/Date

Maple Lawn Nursing Home

United States v, Marion County Nursing Home District, 2:13-CV-00026 E.D. Mo. 2013

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D. Juvenile justice facilities:

Facility or Facilities Case or Agreement Court/Date

Bayamon Detention Center; Centro Tratamiento Social Bayamon; Centro Tratamiento Social Humacao; Centro Tratamiento Social Villalba; Centro Tratamiento Social Guayama; Guali Group Home; and Ponce Detention and Social Treatment Center for Girls

United States v. Commonwealth of Puerto Rico, 9 4-2080 CCC D. P.R. 1994

Arkansas Juvenile Assessment and Treatment Center

United States v. Arkansas, 03CV00162 E.D. Ark. 2003

Oakley Training School United States v. Mississippi, 3:03 CV 1354 BN S.D. Miss. 2003

Circleville Juvenile Correctional Facility; Indian River Juvenile Correctional Facility; Cuyahoga Hills Juvenile Correctional Facility; and Scioto Juvenile Correctional Facility

United States v. Ohio, C2 08 0475 S.D. Ohio 2008

Los Angeles County Juvenile Camps 2009 Settlement Agreement N/A Lansing Residential Center; Louis Gossett, Jr. Residential Center; Tryon Residential Center; and Tryon Girls Center

United States v. New York, 10-CV-858 N.D. N.Y. 2010

E. Jails:

Facility or Facilities Case or Agreement Court/Date Hagatna Detention Center and Fibrebond Detention Facility

United States v. Territory of Guam, 91-00-20 D. Guam 1991

Harrison County Jail

United States v. Harrison County, Mississippi, 1:95 CV5-G-R S.D. Miss. 1995

Sunflower County Jail

United States v. Sunflower County, Mississippi, 4:95 CV 122-B-O S.D. Miss. 1995

Coffee County Jail, Georgia 1997 Settlement Agreement N/A

Saipan Detention Facility; Tinia Detention Facility; and Rota Detention Facility

United States v. Commonwealth of the Northern Mariana Islands, CV 99-0017 D. N. Mar. I. 1999

Muscogee County Jail

United States v. Columbus Consolidated City/County Government, Georgia, 4-99-CV-132 M.D. Ga. 1999

Los Angeles Mens Central Jail, California 2002 Settlement Agreement N/A

Dallas County Jail 2012 Settlement Agreement (converted from consent decree N/A

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in United States v. Dallas County, Texas, 307 CV 1559-N)

Terrell County Jail United States v. Terrell County, Georgia, 04-cv-76 M.D. Ga. 2007

Baltimore City Detention Center, Maryland 2007 Agreement N/A

Oahu Community Correctional Center United States v. Hawaii, CV-08-00585 D. Haw. 2008

Sebastian County Detention Center, Arkansas 2008 Settlement Agreement N/A

Grant County Detention Center, Kentucky 2009 Settlement Agreement N/A Oklahoma County Jail and Jail Annex, Oklahoma 2009 Settlement Agreement N/A

Cook County Jail United States v. Cook County, Illinois, 10-cv-2946 N.D. Ill. 2010

Lake County Jail United States v. Lake County, Indiana, 2:10-CV-476 N.D. Ind. 2010

Robertson County Jail United States v, Robertson County, 3:13-CV-00392 M.D. Tenn. 2013

Miami-Dade County Detention

United States v. Miami-Dade County, 1:13-CV-21570 S.D. Fla. 2013

St. Tammany Parish Jail 2013 Settlement Agreement N/A

Piedmont Regional Jail Authority, Virginia

United States v. Piedmont Regional Jail Authority, 3:13-CV-646 E.D. Va. 2013

F. Prisons:

Facility or Facilities Case or Agreement Court/Date Golden Grove Correctional and Adult Detention Facility

United States v. Territory of the Virgin Islands, 86-265 D. V.I. 1986

Saipan Prison Complex

United States v. Commonwealth of the Northern Mariana Islands, CV-99-0017 D. N. Mar. I. 1991

Guam Adult Correctional Facility United States v. Territory of Guam, 91-00-20 D. Guam 1991

Taycheedah Correctional Institution, Wisconsin United States v. Doyle, 08-C-0753 E.D. Wis.2008

Erie County Detention Center and Holding Facility

United States v. Erie County, New York, 09-CV-0849 W.D. N.Y. 2009

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V. Termination of CRIPA Cases

In Fiscal Year 2013, the Division terminated one CRIPA case. In May 2013, the Division

and the State of Wisconsin jointly moved to dismiss United States v. Doyle, 08-C-753 (E.D. Wis.

2008) regarding conditions at Taycheedah Correctional Institution. Following an investigation

of the prison, the Division issued its findings in 2006. The Division found that the prison failed

to provide inmates with adequate psychiatric treatment and mental health care. Thereafter, in

2008, the parties entered into a memorandum of agreement to improve the care at the prison. The

agreement provided for: measures to improve mental health care, crisis services and psychiatric

treatment of inmates; the implementation of a compliance and quality assurance program; and a

jointly selected consultant to provide technical assistance and biannual reporting of the steps

taken by the State to comply with the agreement. During the Fiscal Year, the jurisdiction

fulfilled the terms of the settlement agreement, and the parties moved for dismissal of the

lawsuit. The Court dismissed the lawsuit on May 14, 2013.

VI. New CRIPA Investigations

The Division initiated one CRIPA investigation during Fiscal Year 2013, of Julia

Tutwiler Prison for Women in Alabama. The investigation addresses allegations that prisoners

are subjected to sexual abuse by prison staff in violation of their constitutional rights; allegations

that the prison fails to report and prevent sexual abuse; and allegations that the prison fails to

provide adequate mental health and medical care to victims of sexual abuse.

VII. Findings Letters

During the Fiscal Year, the Division issued two findings letters, pursuant to Section 4 of

CRIPA, 42 U.S.C. ' 1997b, regarding two facilities. On May 22, 2013, the Division issued a

findings letter regarding conditions at the Escambia County Jail in Florida. This jail houses

nearly 1,300 prisoners. The Division investigated conditions at the jail related to sufficient

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security levels, sanitation and environment, and the adequacy of medical and mental health care

for prisoners. The Division found that, although conditions were improved through the

implementation of new reforms, the jail consistently violated the constitutional rights of the

prisoners. In particular, the Division found that staffing shortages led to unconstitutional

inadequacies in mental health care and risks of harm to prisoners. The Division also found that

the jail discriminated against prisoners based on race by implementing a policy and practice that

segregated certain housing for only African-American prisoners.

On May 31, 2013, the Division issued a findings letter regarding the State Correctional

Facility at Cresson in Pennsylvania. The Division began this investigation in December 2011 and

investigated conditions at the prison regarding the use of solitary confinement on prisoners with

serious mental illness and intellectual disabilities. The Division found that the prison routinely

locked prisoners with serious mental illness in their cells for 22 to 23 hours a day. The Division

also found that the prison subjects these prisoners to harsh and punitive conditions, including

excessive use of force, and denies them basic necessities. The Division concluded that the

prison’s use of solitary confinement caused serious harms to prisoners, including mental

decompensation, clinical depression, psychosis, self-mutilation, and suicide. In addition, the

Division found that the prison relied on solitary confinement to warehouse its prisoners with

serious mental illness because of deficiencies in its mental health program. During the Fiscal

Year, the Division expanded this investigation into all of the prisons in the Pennsylvania

Department of Corrections.

In these investigations, the Division made significant findings of constitutional and

federal statutory deficiencies. As envisioned by Congress, enforcement of CRIPA continues to

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identify conditions that subject residents of publicly operated institutions to grievous harm.

42 U.S.C. ' 1997a (a).

VIII. Investigation Closures

In Fiscal Year 2013, the Division closed its investigation of William F. Green State

Veteran’s Home in Alabama, after the facility fully complied with the memorandum of

understanding, resulting in improved health care, protecting residents from harm, and policies

and procedures to ensure that residents and potential residents are served in the most integrated

settings appropriate to their needs. The Division also ended its investigation of Worcester

County Jail in Massachusetts following a change in facility leadership and the introduction of

reforms there responsive to the issues raised in the Division’s Findings Letter. Additionally, the

Division closed its investigation of Delaware Correctional Center after the State achieved

substantial compliance with a memorandum of agreement and implemented reforms in medical

care, mental health care, and suicide prevention.

The Division ended its investigation of Dougherty County Jail after the jurisdiction made

improvements to conditions with regards to staffing, infrastructural issues, grievances, use of

force, and environmental health and safety at the Jail. The Division closed its investigation of

the Alexander, Arkadelphia, and Booneville Human Development Centers in Arkansas after an

adverse decision in a related matter brought by the Division.

Lastly, the Division ended its investigation of Clyde E. Choate Developmental Center

after the State significantly expanded its commitment to community-based services. The

Division will continue to monitor the State’s efforts.

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IX. Technical Assistance

Where federal financial, technical, or other assistance is available to help jurisdictions

correct deficiencies, the Division advises responsible public officials of the availability of such

aid and arranges for assistance when appropriate. The Division also provides technical

assistance through the information provided to jurisdictions by the Division’s expert consultants

at no cost to state or local governments. Often, after expert consultants complete on-site visits

and program reviews of the subject facility, they prepare detailed reports of their findings and

recommendations that provide important information to the facilities on deficient areas and

possible remedies to address such deficiencies. In addition, during the course (and at the

conclusion) of investigatory tours, the Division’s expert consultants often meet with officials

from the subject jurisdiction and provide helpful information regarding specific aspects of their

programs. These oral reports permit early intervention by local jurisdictions to remedy

highlighted issues before a findings letter is issued.

In addition, to ensure timely and efficient compliance with settlement agreements, the

Division has issued numerous post-tour compliance assessment letters (and in some cases,

emergency letters identifying emergent conditions) to apprise jurisdictions of their compliance

status. These letters routinely contain technical assistance and best practices recommendations.

X. Responsiveness to Allegations of Illegal Conditions

During Fiscal Year 2013, the Division reviewed allegations of unlawful conditions of

confinement in public facilities from a number of sources, including individuals who live in the

facilities, relatives of persons living in facilities, former staff of facilities, advocates, concerned

citizens, media reports, and referrals from within the Division and other federal agencies. The

Division received 6,423 CRIPA-related citizen complaint letters and numerous CRIPA-related

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citizen complaint telephone calls during the Fiscal Year. In addition, the Division responded to

603 CRIPA-related inquiries from Congress and the White House.

The Division prioritized these allegations by focusing on facilities where allegations

revealed systemic and serious deficiencies. In particular, with regard to facilities for persons with

mental illness or developmental disabilities and to nursing homes, the Division focused on

allegations of abuse and neglect, adequacy of medical and mental health care, and the use of

restraints and seclusion. Consistent with the requirements of Title II of the ADA and its

implementing regulations, 42 U.S. C. § 12132 et seq.; 28 C.F.R. § 35.130(d), the Division,

through its CRIPA work, also ensured that jurisdictions operate facilities in a manner consistent

with their obligations to provide services to institutionalized persons in the most integrated

setting appropriate to meet their needs.

Similarly, with regard to its work in juvenile justice facilities, the Division focused on

allegations of abuse, adequacy of mental health and medical care, and provision of adequate

rehabilitation and education — including special education services. The Division also began

expanding its juvenile practice into new areas. Using its authority under a section of the Violent

Crime Control and Law Enforcement Act of 1994, the Department has investigated the conduct

of police in arresting children for school-based offenses, and has examined whether entities

involved in the administration of juvenile justice— including police, juvenile courts, and juvenile

probation systems—comply with children’s procedural due process rights, with the constitutional

guarantee of Equal Protection, and with federal laws prohibiting racial discrimination. The

Department has made findings of civil rights violations regarding the administration of juvenile

justice in two jurisdictions. In one of these matters, in Shelby County, Tennessee, the

Department and the jurisdiction entered into a settlement and are working cooperatively to

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resolve concerns. The second matter, United States

v. City of Meridian, et al., (S.D. Miss) is currently in litigation.

In addition, in a settlement involving the Los Angeles City juvenile justice camps, the

Division looked beyond institutional conditions by expanding a long-standing conditions

agreement to incorporate youths’ access to community-based alternatives to detention.

XI. Conclusion

In Fiscal Year 2014 and beyond, the Division intends to continue aggressive

investigation and enforcement under CRIPA, ensuring that settlements resulting from its

enforcement efforts are strong enough to adequately address unlawful deficiencies. The Division

will also continue to work with jurisdictions to craft agreements that focus on bringing them into

compliance. To that end, the Division does not enter into agreements that terminate on a pre-set

date but only enters into agreements that terminate when the jurisdiction has engaged in

necessary reforms.

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VA u.s. Department of Veterans Affairs

Office of the Genera I Counsel MAR - 4 2014Washington DC 20420

In Reply Refer To:

Judy C. Preston, Deputy Chief Special Litigation Section Civil Rights Branch U. S. Department of Justice 601 D Street, N.W. Washington, D.C. 20004

RE: Information for inclusion in the Attorney General Report to Congress on the Civil Rights of Institutional Persons Act (42 USC 1997f)

Dear Ms. Preston:

Thank you for the opportunity to submit a contribution to the Attorney General's Report to Congress pursuant to the Civil Rights of Institutionalized Persons Act (CRIPA). The Department of Veterans Affairs believes we meet all existing promulgated standards for CRIPA and, in so doing, ensure the constitutionally guaranteed rights of our patients and residents. The enclosed information is provided for inclusion in your report.

~n~:~J~{I n;::. Gunn ,/)

General Counsel

Enclosure

DEPARTMENT OF VETERANS AFFAIRS

The Department of Veterans Affairs (VA) has multiple ongoing programs to

protect the civil rights of patients in its facilities. VA regulations published at 38 C.F.R.

17.33 identify the rights of patients. All patients are advised of these rights on their

admission to a facility. The statement of patients' rights is required to be posted at each

nursing station, and all VA staff working with patients receive training regarding these

rights. Id. at 17.33(h).

The applicable regulations set forth that the specified patients' rights "are in

addition to and not in derogation of any statutory, constitutional or other legal rights."

Id. at 17.33(i). The regulations set forth specific procedures for VA to follow when

restricting any rights, id. at 17.33 (c), and establish grievance procedures for patients to

follow for any perceived infringements of rights. Id. at 17.33(g). In addition to the

regulations, the Veterans Health Administration (VHA) has issued a directive prohibiting

discrimination based on race, color, national origin, limited English proficiency, age, sex,

handicap, or as reprisal. VHA Directive 1019, Nondiscrimination in Federally­

Conducted and Federally-Assisted (External) Programs (May 23, 2013).

VA further protects patients' civil rights through its program of hiring individuals to

serve as Patient Advocates. The purpose of VA's Patient Advocacy Program is "to

ensure that all veterans and their families, who are served in VHA facilities and clinics,

have their complaints addressed in a convenient and timely manner." VHA Handbook

1003.4, VHA Patient Advocacy Program, paragraph 3 (September 2, 2005). The

Advocates assist patients in understanding their rights and represent them in the

enforcement of those rights. VA also facilitates the representation of patients by

external stakeholders, including, but not limited to, veterans service organizations and

state protection and advocacy systems, which seek to represent patients in VA facilities.

Id. at paragraph 8.

In addition, patients are also protected by VA regulations requiring the full

informed consent of patients or, where applicable, their surrogates, before any

proposed diagnostic or therapeutic procedure or course of treatment is undertaken.

38 C.F.R. 17.32.

VA believes the receipt of high-quality medical care is the right of all patients, and

takes action to achieve its provision through a number of internal mechanisms. VA

operates ongoing active peer review programs designed to discover and correct

problems in the provision of care. Additionally, pursuant to Presidential Executive Order

12862 (1993) which requires patient surveys and use of the resultant feedback to

manage agency operations, patients are periodically surveyed to determine their

satisfaction with the health care provided to them. Also, the VA Office of the Inspector

General and the VA Office of the Medical Inspector conduct investigations of complaints

concerning the quality of health care. All of these mechanisms serve to protect the civil

rights of patients in facilities operated by VA.

(VA participates in two grant-in-aid programs with the states, to provide

construction and renovation funds and to provide per diem payments for care of eligible

veterans in State homes; however, such homes are not Federal facilities).

U.S. Departillent of Justice

Federal Bureau of Prisons

Office of rlre Dir('clor Wa.~hiflglon, DC 2053-1

February 28, 2014

MEMORANDUM FOR JUDY C. PRESTON, DEPUTY CHIEF SPECIAL LITIGATION SECTION CIVIL RIGHTS DIVISION, DOJ

Sara M. FROM:

SUBJECT: Response for the Attorney General's Report to Congress for FY 2013 Pursuant to the Civil Rights of Institutionalized Persons Act of 1997

The Bureau of Prisons appreciates the opportunity to report our actions during FY 2013 as related to the Attorney General's Report to Congress for FY 2013 Pursuant to the Civil Rights of Institutionalized Persons Act of 1997.

The following is provided for insertion into the report:

FEDERAL BUREAU OF PRISONS

The Federal Bureau of Prisons (Bureau) adheres to the correctional standards developed by the American Correctional Association (ACA), the Prison Rape Elimination Act (PREA) of 2003 (Public Law 108-79; September 4, 2003), and 28 CFR Part 115, National Standards To Prevent, Detect, and Respond to Prison Rape; Final Rule, dated June 20, 2012. These standards cover all facets of correctional management and operation, including the basic requirements related to life/safety and constitutional minima, which includes provisions for an adequate inmate grievance procedure, and a zero tolerance

toward all forms of sexual activity, including sexual abuse and sexual harassment.

ACA standards have been incorporated into the Bureau's national policy, as well as the program review guidelines. Currently, 115 of the Bureau's 119 institutions and the Bureau's Headquarters are accredited by the Commission on Accreditation for Corrections. Additionally, the agency's two training centers, Staff Training Academy and Management and Specialty Training Center, will be attending their ACA panel hearings in August 2014 to be accredited. The newly activated facilities in Berlin, New Hampshire, and Al iceville, Alabama, are preparing for their ini t ial accreditations. MCC San Diego and FDC Miami lost accredi tat ion i however, MCC San Diego has re-applied and is scheduled for accreditation in FY 2014. The Bureau uses the ACA standards mentioned above for institution accreditation.

Accredited institutions are subject to interim audits by the Commission to monitor standards compliance. Particular attention is given in the vital areas of inmate rights, healthcare, security, safety, and sanitation. The standards are reviewed at least annually for continued compliance, by institutional staff, through the operational review process. In addition to operational reviews, program reviews are conducted at all federal prisons in each discipline at least once every 3 years to monitor policy compliance. In FY 2013, there were 532 separate program reviews conducted by organizationally independent Bureau examiners which included a review of ACA standards. This number is higher than FY 2012, partially because of the newly activated facilities.

PREA audits for federal institutions began on August 20, 2013, with 5 institutions being audited for FY 2013. Also, at least 1/3 of the Bureau's federal institutions will be audited each year for the first three-years with the Central Office being audited annually to determine compliance with each PREA standard.

The Bureau utilizes a medical classification system that identifies each inmate's medical and mental health needs, along with the forensic needs of the court. Additionally, the Bureau assigns inmates to facilities (identified as Care Levels 1 through 4) with appropriate in-house and community health care resources. All Care Level 2, 3, and 4 institutions are required to be accredited by The Joint Commission on Accreditation of Healthcare Organizations. Currently, all 77 sites are accredited by The Joint Commission.

If you require additional information, please contact Joseph Pecoraio in my office at (202)307-0281.